Beating-heart coronary artery bypass grafting using a miniaturized extracorporeal circulation system.
BACKGROUND
Experience with miniaturized coronary artery bypass (CAB) systems in coronary artery bypass graft (CABG) surgery on the beating heart is limited. We used a relatively new miniaturized cardiopulmonary bypass (CPB) system, which we termed assisted CAB (ACAB), to perform CABG on the beating heart in 110 patients, and we analyzed clinical outcomes in this patient group.


METHODS
Between January 2004 and September 2006, we used ACAB to perform CABG on the beating heart in 110 patients. The mean patient age was 73 +/- 8.1 years. The ACAB system uses a small prime volume of only 500 mL, and the circuit is shorter than that used in conventional CPB. In addition, the tubing and oxygenator systems were surface-coated with phosphorylcholine. The initial heparin dose was 150 IU/kg, with a target activated clotting time of >250 seconds. With this management, none of the patients experienced system thrombosis. We did not use cardioplegia or aortic crossclamping and did not routinely retransfuse cardiotomy blood. Observational data for the 110 patients were analyzed.


RESULTS
The mean number of anastomoses performed was 2.67. The rate of perioperative infarction was 1.8% (2 patients). Perioperative mortality was 7% (8 patients). The mean EuroSCORE for all patients was 6.4 +/- 4, whereas it was 13.75 +/- 6.18 for the patients who died. Mean CPB time was 64.96 +/- 16.66 minutes.


CONCLUSIONS
In our experience, beating heart CABG supported by a miniaturized CPB is a safe procedure with acceptable perioperative results.
Reber
Delawer
D
Department of Cardiothoracic Surgery, Bergmannsheil Bochum, Ruhr-University Hospital, Bochum, Germany. delawer.reber@ruhr-uni-bochum.de
Fritz
Markus
M
Tossios
Paschalis
P
Buchwald
Dirk
D
Lindstaedt
Michael
M
Klak
Krzysztof
K
Marks
Peter
P
Laczkovics
Axel
A
D000368:Aged; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects* / Q000295:instrumentation* / Q000379:methods; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005112:Extracorporeal Circulation / Q000009:adverse effects* / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008904:Miniaturization; D009203:Myocardial Infarction / Q000209:etiology*; D016896:Treatment Outcome